POS1282 CARDIAC MAGNETIC RESONANCE IN ANTI-SYNTHETASE SYNDROME: THE ADDITIONAL VALUE OF T2 MAPPING TO DETECT MYOCARDITIS
Authors: G. De Luca, C. Campochiaro, A. Ferlito, G. Peretto, A. Palmisano, A. Esposito, L. Dagna
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Myocarditis can be a subtle and underdiagnosed manifestation of anti-synthetase syndrome (ASS), and its occurrence is associated with a poor prognosis. Cardiac magnetic resonance (CMR) is the diagnostic modality of choice for the non-invasive diagnosis of myocarditis, which historically relies on the 2009 Lake Louise Criteria (LLC) <sup>[1]</sup>. LLC, however, have a low diagnostic accuracy in patients with coexisting myositis. <h3>Objectives</h3> To investigate the performance of the mapping techniques included in the revised LLC <sup>[2]</sup> for the identification of ASS myocarditis. <h3>Methods</h3> CMR data (right and left ventricular function and morphology, early and late gadolinium enhancement [LGE], T2 ratio, and T1 mapping, extracellular volume [ECV] and T2 mapping) of ASS patients diagnosed with myocarditis were reviewed. Myocarditis was clinically defined by the presence of signs and/or symptoms of ASS heart involvement with increased high-sensitive troponin T (hs-TnT) and/or NT-proBNP serum levels and at least an abnormality at 24 h ECG Holter and/or echocardiography and/or CMR. <h3>Results</h3> We identified 11 patients (mean age 58 ±13 years; females 45%; anti-Jo1 55%, antiPL-7 27%) with ASS myocarditis. Dyspnea was the most frequently reported symptoms (64%), 4 patients (36%) had echocardiographic abnormalities, while 24-hour-ECG Holter was normal in all patients. At baseline, troponin T levels were raised in all but 1 patient (mean value 461 ±351 ng/L), while NT-proBNP levels were raised in 45% of patients (mean value 1802 ±1484 pg/mL). All patients had at least one CMR abnormality: increased ECV in all patients, LGE in 10 (91%), and T2 mapping &gt;50 ms in 10 (91%). Median T1 and T2 mapping were 1079 [range 906-1172] ms and 53.2 [range 48.8-57.4] ms, respectively. No statistical significant correlation emerged between CMR parameters (T1 mapping, T2 mapping and ECV) and disease parameters (troponin, NTproBNP, CPK levels and inflammatory markers). Six patients satisfied the 2009 LLC, 10 the 2018 LLC. With the new criteria including T2 mapping, the sensitivity improved from 54% to 91%. <h3>Conclusion</h3> The CMR mapping techniques improve the sensitivity to detect myocardial inflammation in patients with ASS-related heart involvement. The evaluation of T2 mapping increases diagnostic accuracy for the recognition of myocardial inflammation in ASS and should be always performed in ASS patients with suspected myocarditis. <h3>References</h3> [1]Friedrich MG, et al. J Am Coll Cardiol. 2009 Apr 28;53(17):1475-87. [2]Ferreira VM, et al. J Am Coll Cardiol. 2018 Dec 18;72(24):3158-3176. doi: 10.1016/j.jacc.2018.09.072. PMID: 30545455. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Giacomo De Luca Speakers bureau: Novartis, Pfizer, SOBI, Janssen, MSD, Boehringer Ingelheim, Corrado Campochiaro Speakers bureau: Novartis, Pfizer, SOBI, Janssen, MSD, Boehringer Ingelheim, Arianna Ferlito: None declared, Giovanni Peretto: None declared, Anna Palmisano: None declared, Antonio Esposito: None declared, Lorenzo Dagna Speakers bureau: Novartis, Pfizer, SOBI, Janssen, MSD, Boehringer Ingelheim, Lilly.